Side-by-Side Guide: Lateral Access vs. Open Spine Surgery

The main differences between lateral access and open spine surgery are significant and impact various aspects of the surgical experience. First, the surgical approach differs markedly; lateral access surgery employs a small incision, typically 2-3 inches, made on the side of the body, which allows surgeons to avoid major back muscles. In contrast, open spine surgery requires a larger incision, usually 5-6 inches, along the midline of the back, necessitating muscle retraction to access the spine.

The duration of the procedures also varies, with lateral access surgery generally being shorter, typically lasting 1-2 hours, while open surgery often takes longer, usually ranging from 2-4 hours or more, particularly for complex cases. This difference in duration contributes to the recovery time; patients undergoing lateral access surgery often return to light activities within 2-4 weeks, whereas those who have open surgery typically need 4-6 weeks before resuming similar activities.

Hospital stays reflect these differences as well, with lateral access patients usually spending 1-3 days in the hospital, while open surgery patients generally require 3-5 days or more. The minimally invasive nature of lateral access surgery results in less muscle and tissue damage, leading to reduced postoperative pain compared to open surgery, which often involves more extensive muscle retraction and can result in significant pain levels.

Rehabilitation timelines also differ, as lateral access surgery allows for earlier initiation of physical therapy, typically within 1-2 weeks post-surgery. In contrast, rehabilitation for open surgery usually begins 2-4 weeks after the procedure and tends to be more extensive. Additionally, the cosmetic outcomes vary; lateral access surgery results in smaller scars, while open surgery leaves larger scars.

Finally, the applicability of each approach varies based on the complexity of the spinal condition. Lateral access surgery is suitable for many conditions but may have limitations when addressing more complex cases. On the other hand, open surgery remains the standard for treating severe spinal deformities and performing extensive reconstructions, providing comprehensive direct visualization of the spine.

Lateral access surgery usually has a shorter recovery time than open surgery because there is a smaller incision and less tissue disruption.

Yes, there more risks associated with open spine surgery than lateral access surgery. Open spine surgery carries a higher risk of blood loss, infection, and tissue damage. Open spine surgery is also associated with a larger scar, longer recovery, and more postoperative pain.

To determine if you are a candidate for lateral access spine surgery, several factors should be considered. First, the specific spinal condition you are experiencing plays a crucial role; lateral access surgery is commonly used to treat conditions such as degenerative disc disease, recurrent disc herniation, spinal instability, spondylolisthesis, and certain types of scoliosis. If you have not found relief from conservative treatments like medications, steroid injections, or physical therapy, you may be a candidate for surgical intervention. Significant back pain, with or without accompanying leg pain that has not responded to non-surgical treatments, is often an indication for considering this procedure.

Your overall health is also important, as good general health is necessary to tolerate the surgery and anesthesia. Additionally, your specific spinal anatomy will be evaluated, as factors such as vertebral body shape, transitional levels, and iliac crest morphology can influence the feasibility of lateral access surgery. Imaging results, including plain films and quality MRIs, will be assessed by your surgeon to determine the condition of your spine and whether lateral access is appropriate.

Ultimately, a qualified spine surgeon will need to evaluate your case, taking into account all of these factors, to determine if you are a suitable candidate for the procedure. If you have had unsuccessful prior spine surgeries or treatments, lateral access may be considered as an alternative approach. The decision regarding whether lateral access spine surgery is right for you should be made in consultation with a spine specialist who can provide personalized advice based on your condition, medical history, and specific needs.

Dr. Strenge will be able to tell you if you indeed qualify for lateral access spine surgery

Before deciding on a spine surgery procedure, it is important to ask your spine surgeon several critical questions to ensure you are well-informed and prepared. Firstly, inquire about the specific type of surgery being recommended and the rationale behind it. Understanding the source of your pain and how it was confirmed is crucial. Ask the surgeon to explain the procedure in detail, including the duration of the surgery and whether it can be performed endoscopically or requires open surgery.

Discuss the potential side effects, risks, and complications associated with the surgery, including any patient-specific risks due to your health status. It is also important to know what the surgeon plans to do if they encounter a different spine issue during the procedure. Ask whether you need to donate your own blood and why, if applicable.

Clarify who will be performing the surgery, including the roles of any students or other surgeons, and their qualifications. Understanding the long-term consequences of the proposed procedure, such as the likelihood of needing additional surgeries or the potential for degeneration in other spine levels, is also essential.

Explore your nonsurgical options and their expected duration of effectiveness, as well as the natural progression of your condition if left untreated. Additionally, ask about the expected degree of postoperative pain, the length of the hospital stay, and whether a family member can stay with you in the hospital. Discuss how pain will be managed during your hospital stay and after discharge.